The Midwifery Association of
Ireland (MAI) would like the opportunity to respond to the article by Laura
Kennedy entitled The natural childbirth
movement has a lot to answer for, which appeared in The Irish Times on
April 17th 2019.

Midwives complete a four years
honours degree programme and are specifically educated to support women in
normal pregnancy, labour and in early parenthood. We know the many benefits of supporting
women to be confident in their own ability to birth without routine, unnecessary
and unsought interventions. This is especially important in Ireland, because
the default position is a highly prescriptive, regulated medicalised birth.
This became entrenched in the early 1970s with the introduction of Active
Management of Labour (AML) protocol. This led to all Irish women in labour in our 19 maternity units,
regardless of wellness, being set strict time limits for every stage of labour:
induction if labour does not start ‘on time’, waters broken and a drip with
oxytocin if not dilating quickly enough, pain relief, episiotomy, assisted
vacuum or forceps delivery all follow on inexorably. This is not to negate the
role of the obstetrician nor the use of technology for women who have genuine problems
and need medical assistance to birth safely. However, not all pregnant women require
medical intervention nor do they want it.

Laura Kennedy, quoting Dr Amy Tuteur,
an American obstetrician, states that “childbirth
is not inherently safe – obstetrics, anaesthesia and C-sections have made it
safe. Thank goodness for that.” We would disagree. Far from making birth safer, best international evidence shows that
routine interventions associated with the biomedical model of birth for all women, are creating risks and
problems where there were none. In fact, the US is the only high-income country
in which maternal mortality rates are rising, and this is due in part to
over-intervention in a litigious and highly medicalised birth culture. In what
is one of the most significant and empowering events in many women’s lives, the
physiological process of birth is being undermined by the highly
interventionist, time constrained and throughput focus of the AML protocol. The
majority of women entering the maternity services start off low risk, but can
end up high risk because of their encounter with this industrial model of
birth.

Bump2Babe: The Consumer Guide to Maternity Services in
Ireland, published by Cuidiú, the Irish Childbirth Trust revealed that in 2017, seven out
of our 19 maternity units had induction rates of 42 per cent and over for first
time mothers. Caesarean section rates are likewise increasing at an alarming
rate averaging at around 30 per cent, with only one hospital below that at 28.6
per cent, and three hospitals with rates of over 40 per cent.

Laura Kennedy
decries a proud husband who “was heaping
praise upon her [his wife] “Trojan effort” and “steely resolve” in bringing their child into the world
without the helpful effects of pain medication”. Her assumption is that
pain is bad and should be avoided and pain medication is helpful. The hormone that
causes labour contractions, oxytocin, is known widely as the ‘love hormone’ or
the ‘hormone of trust’ which gives a sense of calm and wellbeing. The endorphins
which are produced in tandem with oxytocin in labour are the body’s natural
pain killers, which enable women to manage labour pain without medication if
they choose. These hormones also promote postnatal feelings of euphoria,
maternal-infant bonding and breastfeeding.

Whether or
not a woman opts for an epidural is her choice. Women state consistently that
they need to be in control and to be supported to make the decisions they want
about their care throughout the birth process. Midwives are not opposed to the epidural.
Midwives respect women whatever their decisions in labour. The core problem is
how and whether women get to make their decisions supported by their midwife,
because there are simply too few midwives.

What Laura
Kennedy has missed entirely is that the acute shortage of midwives, along with
our national reliance on a badly out-of-date medical model of birth (which is out
of step with international best practice) and an acute lack of resources to fully
utilise all that women should be able to draw on, including birthing pools, is
depriving women of the supported care they need in order to labour as they feel
is best for them. For the sake of comparison, Northern Ireland with 23,000
births last year has eleven midwifery-led units. We have two for over 60,000
births.

And we have a
stalled National Maternity Strategy which has just had its funding cut.

The more than
a thousand women who rang into the recent Liveline programmes about their
distressing experiences, deserve decent maternity services. Until we correct
the grievous problems which afflict our services, midwives will not be there at
critical moments to support women to own their birth experiences.